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Affidavit of Loss (Kim - MK)

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REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO) S. S.
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AFFIDAVIT OF LOSS
I, KIM, JUNGA, of legal age, married, Korean, and a resident of Westwoods Subdivision,
Mandurriao, Iloilo City, Philippines, after having been duly sworn to in accordance with law, do hereby
depose and state that:
1. I was issued by SM Corporation of a Smart Advantage Card (SMAC) under my name Junga
Kim;
2. However, sometime on 12 November 2015 while I was shopping at SM City- Iloilo,
Diversion Road, Mandurriao, Iloilo City, Philippines, I discovered that my wallet where I kept my SMAC
and other identification cards are missing, and the same could not be found despite diligent search and
effort to locate it, hence, is hereby considered LOST for all legal intent and purposes;
3. I am executing this Affidavit of Loss in order to attest to the truthfulness of the foregoing
facts, and to support my application for the reissuance of a new SM Advantage Card under my name, in
lieu of the one lost.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this 24 th day of
November 2015, in the City of Iloilo, Philippines.

JUNGA KIM
Affiant
SUBSCRIBED AND SWORN to before me this 24 th day of November 2015, at Iloilo City,
Philippines, affiant exhibiting to me her Korean Passport, with Passport No. M15525900, issued by
Ministry of Foreign Affairs and Trade, Korea, and valid until 06 November 2023.

ATTY. MA. ANGELA D. MASACOTE


Notary Public
For the City and Province of Iloilo
Comm. Reg. No. 135, valid until 31 December 2016
PTR No. 4983400, 07 May 2015, Iloilo City
IBP No. 1007364, 20 April 2015, Metro Manila
MCLE Compliance Exempt (April 2015)
Attorney’s Roll No. 64235
Doc. No. _____; E-mail Address: maiangelsmile@gmail.com
Page No. _____; Gascon Tingson Caballero Lastimoso Pagunsan Law Firm
Book No. _____; Door 3, 2/F Rosary Building, Iznart Street, Iloilo City
Series of 2015. Telefax: (033) 509-1979

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